tbuckley/cabot-search huggingface dataset:
AB0952 COMPARISON OF THE EFFECT BETWEEN BISPHOSPHONATE AND DENOSUMAB ON BONE MINERAL DENSITY AND RADIOGRAPHIC PROGRESSION IN PATIENTS WITH ANKYLOSING SPONDYLITIS: A PILOT STUDY
Authors: M. Y. Kim, K. Y. Kang, Y. S. Hong
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Osteoporosis is a frequent complication of ankylosing spondylitis (AS). Althogh there are no clear guidelines for the treatment of this secondary osteoporosis in AS, antiosteoporotic agents including bisphosphonate were used according to the same guidelines for primary osteoporosis. Also, approved by European Medicines Agency (EMA) in 2010, denosumab is being widely used. <h3>Objectives</h3> To compare the effect between bisphosphonate and denosumab on bone mineral density and radiographic progression in patients with AS for one year. <h3>Methods</h3> Among twenty-four patients with AS, sixteen patients were treated with bisphosphonate and nine patients with denosumab. BMD in the lumbar spine and right femur was measured by dual energy x-ray absorptiometry (DEXA) at baseline and one year after treatment. Radiographic progression was scored using the modified Stoke AS Spinal Score (mSASSS). Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS), and bone markers (bone-specific alkaline phosphatase (ALP), Collagen type 1 cross-linked C-telopeptide) were used to assess disease activity. <h3>Results</h3> Mean BMD values in the lumbar spine and total hip at one year increased when compared to those at baseline in both the bisphosphnate and denosumab groups (P=0.006 and 0.007 in bisphosphonate group, 0.015 and 0.036 in denosumab group). The increment was greater in denosumab group. The mean BMD in L-spine and total hip increased by 11.0% and 4.9% in denosumab group, while 9.0% and 2.7% in bisphosphonate group. There were no differences in disease activities such as BASDAI, ASDAS-CRP, ESR, and CRP between two groups. mSASSS and number of syndesmophyte also revealed no significant differences, suggesting that denosumab does not adversely affect disease activity and radiographic scores compared to bisphosphonate. <h3>Conclusion</h3> Both bisphosphonate and denosumab increase L-spine and total hip BMD, while not affecting disease activity and spinal new bone formation. Further prospective studies with larger subject numbers are needed. <h3>References</h3> [1]Bone. 2009 May;44(5):772-6. [2]Br J Clin Pharmacol. 2021 Feb;87(2):644-651. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
AB0584 NOT ALL SJÖGREN IS DRY – PRESERVED GLANDULAR FUNCTION IN A SUBGROUP OF PATIENTS WITH PRIMARY SJÖGREN‘S SYNDROME
Authors: A. Lackner, S. Zenz, J. Hermann, J. Thiel, M. Stradner
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Lymphocytic infiltration of the salivary and lachrymal glands is a hallmark of primary Sjögren's Syndrome (PSS). Chronic inflammation leads to progressive destruction of the glands resulting in dryness of the eyes and mouth termed sicca. The course and pace of sicca development in PSS is elusive. <h3>Objectives</h3> To explore the effect of symptom duration on sicca and disease activity. <h3>Methods</h3> Data of patients from the PSS registry of the Medical University of Graz fulfilling the 2016 ACR/EULAR classification criteria for PSS were analysed. We analysed disease duration and total duration of sicca symptoms, Schirmer's test, unstimulated salivary flow test (USF), stimulated salivary flow test (SSF) and ESSDAI (EULAR Sjögren's Syndrome disease activity index), Evaluators Global Assessment (EGA), and focus score of the initial lip salivary gland biopsy. In addition, salivary gland ultrasound (SGUS) was performed using the De Vita scoring system. Free light chains (FLC) ĸ and <b>λ</b>, IgG, rheumatoid factor (RF) IgA were determined. The patient's perspective was analysed by ESSPRI and PSS-QoL. <h3>Results</h3> Data from 159 PSS patients were analysed, of whom 92.6% (n=148) were female. The mean age was 59.3±12.2 years (± standard deviation), with a mean disease duration of 5.5±5.4 years and a mean sicca duration of 11.6±7.4 years. Interestingly, results of USF, SSF, and Schirmer's Test did not decrease with duration of disease or sicca. The lack of correlation was probably caused by a subset of patients in whom glandular function remained stable 10 to 33 years after the onset of sicca. We defined this subgroup of patients by an SSF &gt;0.5ml/min and with a symptom duration &gt;10 years (SFSD10). 19.5% (n=31) of our PSS patient were categorised into this group. SFSD10 showed a significantly higher Schirmers test (median 0 (0-35] vs 3[3-35], p&lt;0.01), lower ESSPRI-dryness (7 [1-10] vs. 5[1-10], p&lt;0.05), PSS-QoL dryness (11[2-22] vs. 8 [3-15], p&lt;0.01), lower IgG (15.5 [7.4-38.1] vs. 11.2 [6.5-30.5], p&lt;0.05) and FLC-K (25 [3.9-134] vs. 20.2 [10.3-63.6], p&lt;0.05) compared to non-SFSD10-group. SGUS De Vita score was significantly lower in the SFSD10 subgroup (median 1 [0-2] vs. 2 [1-3], p=0.045). We found no difference in ESSDAI, focus score, antibody status, pain, fatigue or HRQL between the two groups. <h3>Conclusion</h3> Our results indicate the presence of a subgroup of PSS patients with preserved glandular function despite long-standing disease. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
AB0772 AZATHIOPRINE VERSUS METHOTREXATE AS INDUCTION AND MAINTENANCE THERAPY IN EOSINOPHILIC GRANULOMATOSIS WITH POLYANGIITIS (EGPA): A MONOCENTRIC RETROSPECTIVE STUDY
Authors: A. Milanesi, P. Delvino, S. Quaglini, C. Montecucco, S. Monti
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Despite the clinical differences between EGPA and the other AAVs, treatment guidelines are mostly based on the evidence available for patients with MPA and GPA, due to the lack of enough randomized controlled trials on patients with EGPA [1]. <h3>Objectives</h3> The aim of our study is to analyse the efficacy, safety and steroid-sparing effect of azathioprine (AZA) and methotrexate (MTX) as induction and maintenance therapy in EGPA. <h3>Methods</h3> We collected data from 57 retrospective patients divided in 4 groups according to the treatment received (MTX/AZA as 1<sup>st</sup> line agents in patients with non-severe EGPA or as 2<sup>nd</sup> line agents in patients with severe EGPA previously treated with cyclophosphamide or rituximab). We analysed the data collected during five years of follow up from the initiation of AZA/MTX and compared the patient groups according to time to first relapse, percentage of patients in remission (defined as R1: BVAS=0, R2: BVAS=0 with prednisone ≤5mg/day, R3: BVAS=0 with prednisone ≤ 3,75mg/day – following the MIRRA definition(2)), persistence on therapy, percentage of patients with side effects and average cumulative steroid dose. <h3>Results</h3> There were no significant differences in the time-to-first relapse. No statistically significant differences were found in R1 remission analysis; a higher percentage of patients receiving MTX as 1<sup>st</sup> line therapy obtained R2 remission in the first 6 months (54% vs 12%, p=0,04), R3 remission wasn't achieved by any patient receiving AZA as 1<sup>st</sup> line treatment in the first 18 months of follow up (vs 35% in the MTX group, p=0.07). MTX was correlated with more adverse events (68% vs 33%, p=0.0049) still, persistence on therapy was higher for MTX (median time of suspension was &gt;60months vs 12 months, p=0.03). The average cumulative steroid dose was lower in patients receiving MTX as a maintenance therapy compared to those receiving AZA (6g vs 10g at 5 years-follow up, p=0,039). <h3>Conclusion</h3> This study shows that MTX as 2<sup>nd</sup> line therapy has a better steroid-sparing effect and allows a better persistence on therapy, while as 1<sup>st</sup> line therapy it allows an earlier remission on lower prednisone dose. <h3>References</h3> [1]Chung SA et al. 2021 ACR/Vasculitis Foundation Guideline for the Management of Antineutrophil Cytoplasmic Antibody–Associated Vasculitis. Arthritis Care Res. 2021;73(8):1088–105. [2]Wechsler ME et al. Mepolizumab or Placebo for Eosinophilic Granulomatosis with Polyangiitis. N Engl J Med. 2017;376(20):1921–32. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
AB1832-HPR REMOTE SCREENING OF SELF-REFERRALS FOR JOINT INJECTION CLINIC
Authors: B. Choy, T. Mccoll, M. Reed, S. Bawa
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Intra-articular steroid injections are a valuable option in the management of inflammatory joint flare-ups.<sup>[1]</sup> The Gartnavel General Hospital (GGH), Glasgow operates a joint injection clinic for rheumatological patients via a self-referral system. This allows patients to book clinics directly and enables prompt access to an appointment. This system was modified in July 2022 to include remote screening, allowing for the evaluation of self-referrals prior to booking appointments. Waiting times have decreased significantly from 3 months to 1 week since the use of remote screening. <h3>Objectives</h3> To determine the efficacy of remote screening on self-referrals and identify self-referring patient groups where joint injections are not indicated. <h3>Methods</h3> Retrospective analysis was conducted on patient self-referrals to the joint injection clinic from 07/07/2022 to 07/12/2022. Patient demographics, diagnoses, reasons for rejection and outcomes were analysed. <h3>Results</h3> 108 patients self-referred for a joint injection during this period. There was a 41.7% (n=45) decrease in clinic bookings with remote screening. 50.9% (n=55) were refused on screening; 81.8% (n=45) of these patients were not indicated for a joint injection. 35.2% (n=38) of patients were not under rheumatology review. 25.9% (n= 28) of patients had solely osteoarthritis; 71.4% (n=20) of these patients were rejected and directed to outpatient physiotherapy services. <h3>Conclusion</h3> Remote screening was effective in reducing the patient waiting list for joint injections. The self-referral system used in isolation has significant limitations and has led to clinic booking beyond its capacity. This issue is also exacerbated by self-referrals from non-rheumatological patients. <h3>Reference</h3> [1] Naredo E, Rull M. Aspiration and injection of joints and periarticular tissue and intralesional therapy. Rheumatology. 6 ed. Mosby, 2015: 542-553. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
AB0658 PREVALENCE AND ASSOCIATION OF AUTOANTIBODIES WITH LATENT TUBERCULOSIS IN FIRST-DEGREE RELATIVES OF PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS
Authors: G. Ms, A. Narayanan, C. Kavadichanda, M. M. Thabah, S. Sarkar, P. B. Narasimhan
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Systemic Lupus Erythematosus (SLE) patients have a higher risk of tuberculosis (TB). Detection of latent TB (LTBI) by mycobacterium tuberculosis (TB) IFN-γ release assay (TB-IGRA) is an important step to retard progression to overt TB. Among IGRA positive persons, studies have noted a dose-response relationship, where those with lower baseline levels IFN-γ have lesser risk of progression to over TB. A family history of SLE exerts an increased risk of other autoimmune diseases. Although several studies reported autoantibodies in first-degree relatives (FDR) of SLE patients, association between LTBI and antibodies is not clear. The current study focused on the role of antibodies and LTBI in FDRs of SLE. <h3>Objectives</h3> Study the prevalence of autoantibody levels and LTBI in FDRs of SLE. Evaluate whether seropositivity of autoantibodies confers any risk of TB. <h3>Methods</h3> This is a single centre cross sectional study. FDRs of SLE with no past h/o TB were recruited (n=167). Demography, comorbidity and various autoantibodies were measured by Enzyme Linked Immunosorbent Assay. LTBI was assessed using TB-IGRA. Based on the results of TB-IGRA and seropositivity to antibodies, FDR were divided into 4 groups- Autoantibody positive and negative groups with and without LTBI. Basal IFN-γ and Mtb antigen specific IFN-γ levels were assessed in the unstimulated and Mtb antigen stimulated tubes. <h3>Results</h3> In FDRs, prevalence of autoantibodies and LTBI were 24.5% (n=41) and 25.7% (n=43) respectively. Seropositivity of various autoantibodies were comparable between those with and without LTBI. Among the antibody positive FDR, prevalence of LTBI was 34%, which is higher than the general population cohort. Next, we measured the basal IFN-γ levels in the 4 groups, where the IGRA and autoantibodies positive group had significantly (p=0.014) reduced levels of basal IFN-γ compared to IGRA positive antibody negative group. In the Mtb specific antigen tubes also, the antibody and IGRA positive group showed significantly reduced response compared to the IGRA positive and autoantibody negative group. <h3>Conclusion</h3> The present study showed higher prevalence of LTBI (34%) in the antibody positive FDRs of SLE. Basal and stimulated levels IFN-γ were lower in antibody positive group in contrast to SLE patients who have higher basal IFN-γ. Further longitudinal studies would be required to see the effect of these autoantibodies on LTBI and the risk of progression to TB. <h3>Disclosure of Interests</h3> None declared
AB1117 DRUG SWITCHING IN PATIENTS WITH PSORIATIC ARTHRITIS TREATED WITH TUMOR NECROSIS FACTOR INHIBITOR.
Authors: D. Freites Nuñez, M. Rodríguez Laguna, C. Martinez Prada, B. Fernandez, C. Lajas, L. León, L. Abasolo
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Psoriatic arthritis (PsA) is a chronic inflammatory arthritis, characterized by different clinical manifestations and associated comorbidities that requires targeted treatment. Therapy with Tumor necrosis factor inhibitor (TNFi) represents one of first therapeutic choices. However, PsA patients can experience TNFi failure, lack of efficacy, or adverse events. Although rheumatologists are now able to choose between several drugs, there is a lack of standard patient profiles or detailed treatment algorithms that can be followed when patients need to switch their therapy regimens. <h3>Objectives</h3> To evaluate the switching treatments regardless the cause in patients with PsA treated with TNFi as first biologic agent. <h3>Methods</h3> Retrospective longitudinal observational study. Subjects: Cohort of patients attended in the outpatient rheumatology clinic from January 2006 to December 2021, and followed up to June 2022, diagnosed with PsA according to ICD-10 code and on treatment with TNFi. Main outcome: Therapy regimens switching. Covariables: sociodemographic and clinics. Statistical analysis: Descriptive analysis of the switching therapy, global and stratified by treatment courses. <h3>Results</h3> 125 patients with a diagnosis of PsA and on treatment with TNFi were included, 52% were female, the mean age was 47.87 ± 13.29 years. 94 (75.20%) patients had a history psoriasis at baseline and 95 patients (76%) presented peripheral arthritis and 21 (16.80%) referred inflammatory low back pain as a main clinical domain, 50% of the patients presented at least three PsA domains. 232 courses of treatment were recorded throughout follow-up. As a whole, TNFi was the most used drug with 184 (79.31%) courses, adalimumab 78 (42.39), flowed by interleukin-17 inhibitors (IL-17i) with 30 (12.93%) courses of treatment. 82 (65.60%) patients were on concomitant treatment with conventional DMARDs. From the 125 patients, 49 recorded a switching to a second therapy regimen (32 switched to a second TNFi and 17 to another class of drugs, mainly IL-17i). Then, 28 presented a third change (16 to a different TNFi and 12 switched to another class of drugs) and finally 14 patients had a fourth switching (8 patients received a drug other than TNFi). TNFi switching data expressed in course of treatment is shown in Table 1. Switching after TNFi exposure was mainly due to lack of efficacy with 90 (84.11%) courses of treatment, followed by adverse events with 11 (10.28%). <h3>Conclusion</h3> In our study, although most of the TNFi switching was to a different TNFi, we observed a number of PsA patients receiving another class of drugs after TNFi exposure, and this action increased over the consequent treatment cycles. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
AB0840 ACUTE VASCULAR EFFECTS OF INTRAVENOUS ILOPROST IN SCLERODERMA PATIENTS CAN BE DETECTED BY POWER DOPPLER EXAMINATION OF THE FINGER SUBCUTANEOUS TISSUE
Authors: S. Testoni, L. Magnani, A. Spinella, C. Salvarani, D. Giuggioli, P. Macchioni
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Intravenous iloprost (ILO) is used in the treatment of refractory Raynaud phenomenon and scleroderma (SSc) digital ulcers. To date, there are no recommended imaging modalities to monitor ILO vascular effects. So far few studies explored ultrasound (US) as a tool to assess vascular subcutaneous involvement in patients affected by SSc. <h3>Objectives</h3> We aim to evaluate the acute vascular effects of intravenous ILO infusion by power Doppler US (PDUS) examination at periungual (PU) and finger pulp (FP) subcutaneous areas in a consecutive series of SSc patients. <h3>Methods</h3> Ten consecutive SSc patients who met the ACR/EULAR criteria for SSc referring to our tertiary center for ILO infusions were enrolled in the study. FP and PU vascularization of the 1<sup>st</sup>, 2<sup>nd</sup> and 3<sup>rd</sup> finger of the dominant hand were evaluated before and after ILO infusion (dosage 0.5-2.0 ng/kg/min for 4-6 hours) using an Esaote MylabClassC, (Genoa, Italy) machine equipped with a 22-8 Mhz multifrequency linear probe. All the exams were performed after at least 30 minutes of acclimation in a room with an ambient temperature ranging from 20 to 22C by the same operator (PM). All the images with the highest presence of PD signal were stored for subsequent examination by a rheumatologist (ST) blind to the sequency of the images. The presence of PD signal in every image was scored according to a semiquantitative 0-3 scale (grade 0 no vessels; grade 1: 1-2 visible vessels; grade 2: 3 to 5 vessels, and grade 3 more than 5 vessels). The value of each finger (FP &amp; PU) were summed up to obtain a total patient PD score and values before and after ILO treatment were compared by T-test for paired samples. Single fingers PD improvements after infusion were summed obtaining total improvement respectively for the PU and FP areas. <h3>Results</h3> Clinical and laboratory features of the enrolled patients are reported in Table 1. Mean total PU PD score was 4.2±2.2 at T0 and increased to 7.3±2.5 after treatment <b>(p=0.012).</b> Mean FP total PD score was 2,2±1,81 at T0 and remained unchanged (2,8±1,68) at T1 (p= 0,475). The median number of fingers/patient with PU PD improvement after treatment was 2 (1-3), while the median number of fingers/patient with FP PD improvement was 0,5 [0-3]. <h3>Conclusion</h3> PDUS examination of the PU area could demonstrate an ILO acute effect in SSc patients with long-lasting disease. <h3>References</h3> [1]Schioppo, T., Orenti, A., Boracchi, P., De Lucia, O., Murgo, A., Ingegnoli, F., 2018. Acute and chronic effects of two different intravenous iloprost regimens in systemic sclerosis: a pragmatic non-randomized trial. Rheumatol. Oxf. Engl. 57, 1408–1416. https://doi.org/10.1093/rheumatology/key113 <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
AB0668 BENEFITS OF ANA SCREENING FOR NPSLE IN PATIENTS ADMITTED TO THE DEPARTMENT OF PSYCHIATRY
Authors: Y. J. Lee, S. M. Ahn, S. Hong, J. S. Oh, C. K. Lee, B. Yoo, Y. G. Kim
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Neuropsychiatric systemic lupus erythematosus (NPSLE) presenting with mood disorder, headache, psychosis, and cognitive impairment appears within 1 year of SLE diagnosis in more than half of cases (1, 2). Most studies have focused on the epidemiology of neuropsychiatric manifestations in patients with established SLE (3). Therefore, diagnosing NPSLE in patients who have visited the hospital with psychiatric symptoms is challenging. Although some studies have conducted anti-nuclear antibody (ANA) screening in psychiatric patients, none have occurred in an Asian population (4, 5). <h3>Objectives</h3> We aimed to determine the benefits of ANA screening for NPSLE in patients admitted to the department of psychiatry in Korea. <h3>Methods</h3> We investigated patients admitted to the department of psychiatry who underwent ANA testing between January 2015 and December 2021 at a single tertiary center in Korea. Patients diagnosed with SLE before admission were excluded from this study. Electronic medical records, including ANA titer, extractable nuclear antigen (ENA), complement, brain magnetic resonance imaging, electroencephalogram, and cerebrospinal fluid analysis, were reviewed retrospectively. Diagnosis at psychiatric hospitalization was classified according to the International Classification of Diseases (ICD)-10. <h3>Results</h3> Throughout the study period, 2523 patients were hospitalized, 1355 of whom underwent ANA testing. Three patients with SLE were excluded. The median age of all patients was 40 (27–58), and 897 (66.2%) were female. Of the 1355 patients, 96 (7.1%) were positive with a titer of ≥1:80, and 61 (4.5%) were positive with a titer of ≥1:160. Among the 17 patients who underwent ENA testing, 1 was positive for anti-Ro and anti-La, eventually diagnosed with Sjogren's syndrome. According to the diagnostic classification of admission, there was no significant difference in the ANA positivity rate (p=0.205). <h3>Conclusion</h3> There was no difference in the positivity rate of ANA in the general population when testing was performed for screening purposes on patients admitted to the psychiatric department. Additionally, none of the 1355 patients were diagnosed with NPSLE after undergoing ANA screening. Thus, the benefits of performing routine screening appear to be limited. <h3>References</h3> [1]Arthritis Rheum. 1999 Apr;42(4):599-608 [2]Neurol Clin. 1999 Nov;17(4):901-41 [3]Semin Arthritis Rheum. 2012 Oct;42(2):179-85 [4]Arthritis Care Res (Hoboken). 2022 Mar;74(3):427-432 [5]Medicine (Baltimore). 2016 Nov;95(47):e5288 2 <h3>Disclosure of Interests</h3> None declared